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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Some hematomas cause significant pain because they are trapped in small spaces that do not allow room for the bleeding to expand. For example, a subungual hematoma underneath the fingernail may be intensely painful because there is no room between the nail bed and the tightly adherent nail bed. A few drops of blood that can accumulate from a crush injury like hitting a finger with a hammer may cause exquisite pain. The treatment may include burning a small hole through the nail itself to allow the blood to drain.

Other Hematomas

Other hematomas cause problems because they press on the underlying tissue and that pressure may hamper the normal blood supply and cause long lasting damage and scarring.

• Hematomas of the ear may occur if an injury causes bleeding to the outside helix or cartilage structure of the ear. Blood can get trapped between the thin layer of skin and the cartilage itself and since the ear cartilage gets its blood supply directly from the overlying skin, a hematoma can decrease blood flow causing parts of the cartilage to shrivel and die. This is a common complication seen in wrestlers and boxers.
• Nose injuries may cause a similar issue with the cartilage that makes up the septum of the nose. A septal hematoma may form associated with a broken nose and if not recognized and removed, the cartilage can break down and cause a perforation of the septum.
• Internal bleeding into the abdomen may be life-threatening depending upon the cause and the situation. Hemorrhage and hematoma may be due to a variety of injuries or illnesses but regardless of how the blood gets into the abdomen, the clinical finding is that of peritonitis, irritation of the lining of the abdomen.
• Hematomas may occur in solid organs like the liver, spleen and kidney or they may occur within the walls of the small intestine or colon. Hematomas may also form within the lining of the abdomen called the peritoneum or behind the peritoneum in the retroperitoneal space (retro=behind) where the kidneys are located.
• Hematomas and bleeding due to orthopedic injuries are common because of how blood rich bones are. Bone marrow is where much of the body's blood production occurs and a fracture may cause significant blood loss. Compartment syndrome is an uncommon complication of bleeding and hematoma due to injury. The muscles of the forearm and shin are contained in compartments that tightly adhere to bone. If a hematoma due to fracture or contusion grows and expands, the pressure within the compartment can increase to the point where blood cannot flow to muscle causing it to die. This is a true orthopedic emergency and requires an operation to filet open the compartments to allow room for the swelling and decrease the pressure. Symptoms of compartment syndrome include intense pain made worse with movement of the fingers or toes, numbness and tingling of the extremity, and decreased pulses in the hand or foot.

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